Obstetrical and perinatal morbidity and mortality among in-vitro fertilization pregnancies: a population-based study

Abstract

Purpose: To compare patient characteristics and obstetrical/neonatal outcomes of in-vitro fertilization (IVF) and spontaneously conceived pregnancies. Methods: Using the Nationwide Inpatient Sample, we conducted a retrospective cohort study from 2008 to 2011 comparing IVF conceptions to spontaneous ones. Patient characteristics were descriptively compared, and after adjusting for baseline characteristics with logistic regression, obstetrical/neonatal outcomes were also compared. Results: Among 3,315,764 pregnancies, 5773 (0.17%) were a result of IVF. These patients were more often older, wealthier, Caucasian, non-smokers, and more likely to carry a higher order pregnancy. IVF was strongly associated with pre-eclampsia (OR 1.48, 95% CI 1.32–1.62), gestational diabetes (OR 1.27, 95% CI 1.17–1.38), antepartum hemorrhage (OR 2.04, 95% CI 1.79–2.32), placenta previa (OR 3.14, 95% CI 2.71–3.64), pre-term premature rupture of membranes (OR 1.49, 95% CI 1.30–1.70), chorioamnionitis (OR 1.52, 1.29–1.79), and cesarean section (OR 1.60, 95% CI 1.51–1.70). There was a significantly increased risk of post-partum hemorrhage (OR 2.95, 95% CI 2.29–3.80) and hysterectomy (OR 1.73, 95% CI 1.12–2.69), as well as disseminated intravascular coagulopathy (OR 2.23, 95% CI 1.24–3.99), transfusion (OR 1.78, 95% CI 1.53–2.07), prolonged hospitalization (OR 1.96, 95% CI 1.80–2.14), intrauterine growth restriction (OR 1.81, 95% CI 1.63–2.02), and pre-term birth (OR 1.31, 95% CI 1.22–1.41). Conclusion: IVF is still primarily used by only a subset of the population, and is associated with increased obstetrical and perinatal morbidity and mortality. These patients may benefit from more vigilant antenatal surveillance and delivery in a tertiary care center.